We recognize that the topics and case studies up to this point have been largely based on past experience, which in some settings might not be predictive of future success given the pace of changes happening in medicine today. However, we do believe that it is not just one principle that will define a practice as successful and that regardless of the changes in the global environment of medical practice and health-care delivery, the principle of being able to effect a synergy of the various aspects covered in previous chapters will be essential to both effective health care and rewarding work as a practitioner of pathology. That said, we recognize that it can be difficult to see how these pieces come together into a cohesive solution for all the various iterations of medical practice that do or will exist. With that in mind, we have asked a number of individuals from a wide variety of backgrounds and practice settings to give us their take on what the high-performing pathology practice will look like in the future. Herewith are some of their responses.

To do so, a series of structural and organizational changes need to happen in order to (re)position pathology in the sweet spot of medical practice:

Although I am a strong proponent of merging the business interests of related diagnostic specialties (radiology and pathology, in particular), I also realize that such business and organizational merging will not always be possible. However, bringing these specialties and services together from a logistical and workflow point of view is feasible and should be the minimum goal desired. Radiology and pathology benefit more than any other specialty from fast-developing progress in technology, including the explosive field of molecular and personalized medicine. A walk through a modern laboratory and radiology department is akin to a walk into the future of medical science. I am confident that bringing these two giants together will exponentially enhance their individual visibility in the eyes of the patients and unequivocally assert their central relevance in the mind of all critical health-care stakeholders.

Karim E. Sirgi, MD

CEO, LambdaX3 International

Denver, CO

The POTF in a high-performing practice will avoid marginalization from clinical health care by being fully engaged with clinician colleagues and their patients. The goal of that engagement is high-valued (high quality, lower cost) patient outcomes. The POTF will be a master diagnostician and clinical knowledge-generating consultant, driving diagnostic accuracy in anatomic and clinical pathology services. He/she will develop, validate, and provide access to appropriate new technology for optimal patient care. The POTF will be a steward of patient data sets that drive patient outcomes management, quality of care improvement, and population health management through early predisposition prediction and disease prevention or mitigation interventions. He/she will be an effective and appropriate steward of limited health-care resources, serving as a critical source of appropriate utilization management information for clinicians and patients. This includes improving test selection, improving test accuracy, improving the knowledge derived from these tests, improving the timely and informative communication of results, and improving the follow-up and management of clinical information. This means becoming integral and indispensable members of patient-care coordination teams in the evolving new delivery systems. He/she will cultivate effective interpersonal communication skills and be “good citizens” of their health-care institutions. The POTF will understand their environment—particularly the culture of the clinical care settings—in their health-care institution, their community, and the greater health-care delivery systems at large.

This future “sweet spot” has a number of implications. Organizationally, pathology practices/departments will demand effective leadership , including a meaningful place at the institutional leadership table/organizational chart (e.g., C-suite, medical board/staff leadership). Pathologists must be willing to participate in key institutional committees, including as chairs. They must be effective at interpersonal communication and team play. The financial infrastructure of the practice must understand risk/reward-sharing arrangements, and must have a voice in payer contract negotiations and billing systems. New group members should be recruited from forward-thinking residency training programs that engage trainees in the competencies necessary for success in the future. Recruiting for attitude and effective behavior is as important as recruiting based upon academic achievement. This will be particularly important, because these future high-value practice settings will be collegial and collaborative, with high performance, high expectation and accountability, and open and transparent working environments. The values’ threshold will be set high, and incentives will be aligned accordingly. Recalling Winston Churchill, remember that “A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty.”

Ronald Weiss, MD, MBA

Department of Pathology, University of Utah,

Salt Lake City, UT

One cannot even say that rational “market forces” can be relied upon, as we are now engaged in a grand experiment to replace one set of nonmarket-driven incentives, with another that (as was the first set) is deemed by some authorities as more likely to produce optimal health for individuals and society. A high-performing pathology practice in the past might rationally have built its success upon a strategy of highly efficient, quality production based upon the reimbursement of an 88305, coupled with the ability to market to physician clients who had the independence to choose a pathology lab based on quality and service. Of course, there were other forces acting too, such as local politics and referral patterns , and even (let it be said) legal and nonlegal kickbacks and inducements. But all of this, for better or worse, made up a more predictable context in which decisions could be made about how to organize one’s practice of pathology. At some point (likely only in the distant future), there will perhaps be another relatively stable and predictable context that determines the rules of play within which a pathology practice could rationally lay out such criteria and strategies for success. However, for the foreseeable future, pathologists will be in an environment of high unpredictability that makes the approaches of the past (which were successful for many pathologists) hard to replicate.

So I will take a different track and answer the question not of what the “high-performing” pathology practice will look like, but instead: What are the characteristics of the “high-performing” pathologist likely to be? That is in essence answering the question: What are the personal qualities or guiding principles that can help an individual pathologist thrive in a time of great uncertainty and unpredictable and often negative change for our profession and society?

Luke Perkocha, MD, MBA

Kaiser Permanente

San Francisco, CA

We find ourselves in a challenging and ever-changing environment. Health care has always been the realm of change. However, it is the rate of change that causes concern for so many. There are a few common threads that tomorrow’s pathology group will embrace as essential for success